The Human Physiology Course

Physiology of Aging

Assoc. Prof. Mária Pallayová, MD, PhD

maria.pallayova@upjs.sk

Department of Human Physiology, UPJŠ LF

May 11, 2020 (14th week – Summer Semester 2019/2020)
 Introduction

• 72.0 years was the average life expectancy

at birth of the global population in 2016

• 76.65 years was the average life expectancy

at birth of the Slovak population in 2017
in Slovakia
in Slovakia
 The total body fluid
• In the average 70-kg adult man, the total body water (TBW)
is about 60% of the body weight (about 42 liters).
This % can change, depending on age, gender, degree of obesity.

• As a person grows older, the percentage of TBW gradually

decreases. Aging is usually associated with an increased
percentage of the body weight being fat, which decreases
the percentage of water in the body.
 The skeletal system
 Both cartilage and bone tend to deteriorate as a person
ages. The chemical nature of cartilage changes, and the
bluish color typical of young cartilage changes to an
opaque, yellowish color.
 The chondrocytes die, and reabsorption occurs as the
cartilage undergoes calcification, becoming hard and brittle.
 Calcification interferes with the ready diffusion of nutrients
and waste products through the matrix.
 The articular cartilage may no longer function properly, and
the symptoms of arthritis can appear.
 The skeletal system (cont.)
There are three common types of arthritis:
(1) Osteoarthritis is accompanied by deterioration of the
articular cartilage.
(2) In rheumatoid arthritis, the synovial membrane becomes
inflamed and grows thicker cartilage, possibly due to an
autoimmune reaction.
(3) Gout/gouty arthritis, is caused by an excessive buildup of
uric acid (a metabolic waste) in the blood. The acid is
deposited as crystals in the joints, where it causes
inflammation and pain.
• Osteoporosis is present when weak and thin bones cause
aches and pains. Such bones tend to fracture easily.
 The muscular system
• Muscle mass and strength tend to decrease as
people age.
• Deteriorated muscle elements are replaced initially
by connective tissue and, eventually, by fat.
• With age, degenerative changes take place in the
mitochondria, and endurance decreases.
• Changes in the nervous and cardiovascular
systems adversely affect the structure and function
of muscles.
 The muscular system (cont.)
 Muscle mass and strength can improve remarkably
if elderly people undergo a training program.
 Exercise at any age appears to stimulate muscle
buildup, improves the CVS and reduces the risk of
diabetes and glycation. During glycation, excess
glucose molecules stick to body proteins so that
they cannot function properly.
 Exercise burns glucose and, in this way, helps
prevent muscle deterioration.
 The endocrine system
 Thyroid disorders and diabetes are the most significant
endocrine problems affecting health as we age.
 Both hypothyroidism and hyperthyroidism are seen in the
elderly. Graves disease is an autoimmune disease that
targets the thyroid, resulting in symptoms of cardiovascular
disease, increased body temperature, fatigue, weight loss,
depression, and mental confusion. Hypothyroidism
(myxedema) may fail to be diagnosed because the
symptoms of hair loss, skin changes, and mental
deterioration are attributed simply to the process of aging.
 Type 2 diabetes is associated with being overweight/obese.
 The endocrine system (cont.)
• After adolescence, GH secretion decreases
slowly with aging, finally falling to about 25% of
the adolescent level in very old age.
• As one ages, the average plasma concentration
of GH in an otherwise normal person changes
approximately as follows:
 Possible Role of Decreased Growth Hormone
Secretion in Causing Changes Associated with Aging

 In people who have lost the ability to secrete GH, some

features of the aging process accelerate. E.g., a 50-y/o
person who has been without GH for many years may
have the appearance of a person aged 65.
 The aged appearance seems to result mainly from
decreased protein deposition in most tissues of the body
and increased fat deposition in its place.
 The physical and physiological effects are increased
wrinkling of the skin, diminished rates of function of some
of the organs, and diminished muscle mass and strength.
 The cardiovascular system
• The heart generally grows larger with age (fat deposition in
the epicardium and myocardium and collagenous fibers in
the endocardium).
• With age, the valves, particularly the aortic semilunar valve,
become thicker and more rigid.
• As a person ages, the myocardium loses some of its
contractile power and some of its ability to relax.
• The resting HR decreases throughout life, and the maximum
possible rate during exercise also decreases.
• With age, contractions become less forceful; the heart loses
~1% of its reserve pumping capacity each year after age 30.
The cardiovascular system (cont.)
 In the elderly, arterial walls tend to thicken with
plaque and become inelastic, signaling that
atherosclerosis and arteriosclerosis are present.
 The chances of coronary thrombosis and heart
attack increase with age.
 The occurrence of varicose veins increases with
age.
 Thromboembolism as a result of varicose veins
can lead to pulmonary embolism and death.
The cardiovascular system (cont.)
 The progressive increase in BP with age results
from the effects of aging on the BP control
mechanisms. Kidneys exhibit definitive changes
with age, especially after the age of 50 years.
 A slight extra increase in systolic pressure usually
occurs beyond the age of 60 years. This results
from decreasing distensibility, or “hardening,” of the
arteries, which is often a result of atherosclerosis.
The final effect is a higher systolic pressure with
considerable increase in pulse pressure.
Changes in systolic, diastolic, and mean arterial
pressures with age. The shaded areas show the
approximate normal ranges.
 Cerebrovascular changes
 Almost all elderly people have blockage of some
small arteries in the brain, and up to 10%
eventually have enough blockage to cause stroke.
 Most strokes are caused by arteriosclerotic
plaques that occur in one or more of the feeder
arteries to the brain.
 The plaques can activate the clotting mechanism
of the blood, causing a blood clot to occur and
block blood flow in the artery, thereby leading to
acute loss of brain function in a localized area.
 The nervous system
 After age 60, the brain begins to lose thousands of neurons
a day. By age 80, the brain weighs about 10% less than
when the person was a young adult.
 The cerebral cortex shrinks more than other areas of the
brain, losing as much as 45% of its cells. Therefore, such
mental activities as learning, memory, and reasoning
decline.
 Neurotransmitter production also decreases, resulting in
slower synaptic transmission. As a person ages, thought
processing and translating a thought into action take longer.
This partly explains why younger athletes tend to outshine
older athletes in sports.
 The nervous system (cont.)
• Neurological disorders, especially Alzheimer disease are
more apt to occur in the elderly.
• Alzheimer’s disease is defined as premature aging of the
brain, usually beginning in midadult life and progressing
rapidly to extreme loss of mental powers.
• The clinical features of Alzheimer’s disease include (1) an
amnesic type of memory impairment, (2) deterioration of
language, and (3) visuospatial deficits.
• One consistent finding in Alzheimer’s disease is loss of
neurons in that part of the limbic pathway that drives the
memory process. Loss of this memory function is devastating.
 Human senses
• The need for a hearing aid increases with age.
• Atrophy of the organ of Corti can lead to
presbycusis (age-related hearing decline). First,
people tend to lose the ability to detect high-
frequency tones, and later the lower tones are
affected. Eventually, they can hear speech but
cannot detect the words being said.
• Otosclerosis, an overgrowth of bone that causes the
stapes to adhere to the oval window, is the most
frequent cause of conduction deafness in adults.
 Human senses (cont.)
• Dizziness and the inability to maintain balance
may also occur in older people due to changes in
the inner ear.
• The eye lens does not accommodate well
(presbyopia), and therefore, eyeglasses, contact
lenses, or corrective surgery will most likely be
needed to improve vision.
 Human senses (cont.)
• Three serious visual disorders are seen more frequently
in older persons:
(1) Possibly due to exposure to the sun, the lens is subject
to cataracts. The lens becomes opaque and therefore
incapable of transmitting rays of light. Today, the lens
is usually surgically replaced with an artificial lens.
(2) Age-related macular degeneration is the most frequent
cause of blindness in older people.
(3) Glaucoma is more likely to develop because the
anterior compartment of the eye undergoes a reduction
in size.
The Lymphatic System and Body
defenses
• With advancing age, people become more
susceptible to all types of infections and disorders
because the immune system exhibits lower levels
of function.
• The thymus gland degenerates and as it
decreases in size, so does the number of T cells.
The T cells remaining do not respond to foreign
antigens; therefore, the chance of having cancer
increases with age.
The Lymphatic System and Body
defenses (cont.)
 Among the elderly, the B cells sometimes fail to
form clones, or the antibodies released may not
function well. Therefore, infections are more
common among the elderly.
 The antibodies are more likely to attack the body’s
own tissues, increasing the incidence of
autoimmune diseases.
 The response of elderly to vaccines is decreased.
 Elderly individuals are encouraged to get an
influenza (flu) vaccination each year.
 Blood
 Anemias, leukemias, and clotting disorders
increase in frequency with age.

 Iron deficiency anemia most frequently results

from a poor diet, but pernicious anemia signals
that the digestive tract is unable to absorb
enough vitamin B12.
 Blood
 Leukemia increases in frequency with age
because of both intrinsic (genetic) and extrinsic
(environmental) reasons.

 Thromboembolism, a clotting disorder, may be

associated with the progressive development of
atherosclerosis in an elderly person. When
arteries develop plaque, thromboembolism
often follows.
 The Respiratory System
• Respiratory fitness decreases with age.
• Maximum breathing capacities decline, while the
likelihood of fatigue increases.
• Inspiration and expiration are not as effective in older
persons.
• With age, weakened intercostal muscles and increased
inelasticity of the rib cage combine to reduce the
inspiratory reserve volume, while the lungs’ inability to
recoil reduces the expiratory reserve volume.
• More residual air is found in the lungs of older people.
 The Respiratory System (cont.)
• With age, gas exchange in the lungs becomes less
efficient, not only due to changes in the lungs but also
due to changes in the blood capillaries. The respiratory
membrane thickens, and the gases cannot diffuse as
rapidly as they once did.
• In the elderly, the ciliated cells of the trachea are
reduced in number, and those remaining are not as
effective as they once were.
• Respiratory diseases are more prevalent in older people
than in the general public. Pneumonia and other
respiratory infections are among the leading causes of
death in older persons.
 The Digestive System
 The incidence of GI disorders increases with age.
 Periodontitis, which is common in elderly people,
leads to the loss of teeth and the need for false
teeth.
 The esophagus, which rarely causes any difficulties
in younger people, is more prone to disorders in the
elderly.
 The portion of the esophagus inferior to the
diaphragm can protrude into the thoracic cavity,
causing an esophageal hiatal hernia.
 The Digestive System (cont.)
 In some cases, the lower esophageal sphincter
opens inappropriately and allows chyme to
regurgitate into the esophagus, causing heartburn.
 In some older persons, chest pain may occur when
this sphincter fails to open and a bolus cannot
enter the stomach. Eventually, the esophagus may
develop a diverticulum that allows food to collect
abnormally.
 The Digestive System (cont.)
 Peristalsis generally slows within the alimentary
canal as the muscular wall loses tone.
 Peptic ulcers increase in frequency with age.
 The failure of older people to consume sufficient
dietary fiber can result in diverticulosis and
constipation.
 Constipation and hemorrhoids are frequent
complaints among the elderly, as is fecal
incontinence.
 The Digestive System (cont.)
• The liver shrinks with age and receives a smaller
blood supply than in younger years. Notably, it
needs more time to metabolize drugs and alcohol.
• With age, gallbladder difficulties occur; there is an
increased incidence of gallstones and cancer of
the gallbladder.
• Cancer of the various organs of the GI tract is
seen more often among the elderly (esp. over the
age of 60).
 Age related changes in the GI
system
• Thinner, more fragile epithelium

• Reduction in epithelial stem cells

• Weaker peristaltic contractions

• Effects of cumulative damage

• Increased cancer rates

The Urinary System and Excretion
• Each kidney in the human contains about 800,000 to
1,000,000 nephrons, each capable of forming urine. The
kidney cannot regenerate new nephrons.
• With normal aging, there is a gradual decrease in nephron
number. After age 40, the number of functioning nephrons
usually decreases about 10% every 10 yrs; thus, at age 80,
many people have 40% fewer functioning nephrons than
they did at age 40.
• This loss is not life threatening because adaptive changes
in the remaining nephrons allow them to excrete the proper
amounts of water, electrolytes, and waste products.
Effect of aging on the number of functional glomeruli
The Urinary System and Excretion

 Total renal function in an elderly individual may

be only 50% of that of the young adult.
 With increasing age, the kidneys decrease in
size and have significantly fewer nephrons.
 Microscopic examination shows many
degenerate glomeruli through which blood no
longer flows and many other glomeruli that are
completely destroyed.
The Urinary System and Excretion
 Kidney stones occur more frequently with age,
possibly as a result of improper diet, inadequate
fluid intake, and kidney infections.
 Infections of the urethra, bladder, ureters, and
kidneys increase in frequency among the elderly.
 Enlargement of the prostate occurs in males and
can lead to urine retention and kidney disease.
 Cancer of the prostate and bladder are the most
common cancers of the urogenital system.
The Urinary System and Excretion

 The involuntary loss of urine, called incontinence,

increases with age.

 The bladder of an elderly person has a capacity

of less than half that of a young adult and often
contains residual urine. Therefore, urination is
more urgent and frequent.
 The Reproductive System
 Following menopause, atrophy of the uterus, vagina,
breasts, and external genitals is likely. The lack of
estrogen also promotes changes in the skin (e.g.,
wrinkling) and in the skeleton (e.g., osteoporosis).

 In men, testosterone production diminishes steadily

after age 50, which may be responsible for the
enlargement of the prostate gland. Sperm production
declines with age, yet men can remain fertile well into
old age. With age, however, the chance of erectile
dysfunction due to degenerative vascular changes in
the penis increases.
The Reproductive System (cont.)

• Sexual desire and activity need not decline with

age, and many older men and women enjoy
sexual relationships.

• Men are likely to experience reduced erection

until close to ejaculation, and women may
experience a drier vagina.
 The Integumentary System
 The dermis becomes thinner, the dermal papillae flatten,
and the epidermis is held less tightly to the dermis so that
the skin is looser. Adipose tissue in the hypodermis of the
face and hands also decreases  older people are more
likely to feel cold.
 The fibers within the dermis change with age. The
collagenous fibers become coarser, thicker, and farther
apart; therefore, there is less collagen than before. Elastic
fibers in the upper layer of the dermis are lost, and those in
the lower dermis become thicker, less elastic, and
disorganized. The skin wrinkles because (1) the epidermis
is loose, (2) the fibers are fewer and those remaining are
disorganized, and (3) the hypodermis has less padding.
The Integumentary System (cont.)
 With aging, homeostatic adjustment to heat is limited
due to less vasculature (fewer blood vessels) and fewer
sweat glands. The number of hair follicles decreases,
causing the hair on the scalp and extremities to thin.
Because of a reduced number of sebaceous glands, the
skin tends to crack.
 As a person ages, the number of melanocytes
decreases. This causes the hair to turn gray and the skin
to become paler. In contrast, some of the remaining
pigment cells are larger, and pigmented blotches appear
on the skin.
The Integumentary System (cont.)

 Many of the changes that occur in the skin as a

person ages appear to be due to sun damage.
 Ultraviolet radiation causes rough skin, mottled
pigmentation, fine lines and wrinkles, deep
furrows, numerous benign skin growths, and the
various types of skin cancer.